Comprehensive Assessment Process Research Articles

Get it right, make it easy, see it all: Viewpoints of autistic individuals and parents of autistic individuals about the autism diagnostic process in Australia

BackgroundThe clinical process for being evaluated for an autism diagnosis is often time consuming and stressful for individuals and their caregivers. While experience of and satisfaction with the diagnostic process has been reviewed in the literature, few studies have directly investigated the viewpoints of individuals diagnosed with autism and caregivers of autistic individuals about what is important in the autism diagnostic process. MethodA Q methodological design was employed to capture the subjective viewpoints about the diagnostic process of individuals on the autism spectrum and caregivers of autistic individuals. Thirty-eight participants responded to a set of 66 statements representing different aspects of the autism diagnostic process. ResultsThe analysis identified three significant viewpoints: Get it Right, Make it Easy, and See it All. Participants reflected upon the importance of a comprehensive diagnostic assessment process, ease of diagnostic processes, and a holistic approach to autism diagnosis for autistic individuals and caregivers of autistic individuals. ConclusionsThe findings provide a consumer perspective that encourages reform of the current process for diagnosing autism in Australia, and an insight into what consumers are wanting from diagnostic services. This information is useful for policy-makers and service providers to create a more supportive and client-centred diagnostic process at all levels of service delivery.

Professional Perspectives on Supporting Those with Alcohol-Related Neurocognitive Disorders: Challenges & Effective Treatment

ABSTRACT We interviewed health and social care professionals (n = 17) supporting those with Alcohol-Related Neurocognitive Disorders (ARNDs) to better understand the challenges they face and garner recommendations for effective treatment. Thematic qualitative content analysis was used to systematically analyze interview transcripts. Key challenges associated with treating ARNDs included the challenging behaviors of those with the disorders, their significant physical and mental health needs, stigmatization from others, and a general lack of understanding and awareness of ARNDs. Multiple recommendations for effective treatment were proposed, including first ensuring a comprehensive assessment and diagnostic process is undertaken that informs treatment, multidisciplinary input, and person-specific interventions. ABBREVIATIONS: ARBD: Alcohol-related brain damage: ARND: Alcohol-related neurocognitive disorder: ARD: Alcohol-related dementia: AUD: Alcohol use disorder: DSM: diagnostic & statistical manual of mental disorders: KS: Korsakoff’s syndrome: NICE: National Institute for Health and Clinical Excellence: WE: Wernicke’s Encephalopathy: WKS: Wernicke’s Korsakoff syndrome

Resource allocation decision-making in dementia care with and without budget constraints: a qualitative analysis.

Introduction: Health systems in many different countries have increasingly been reorienting the delivery of dementia care to home and community care settings. This paper provides information on how health and social care professionals (HSCPs) in Ireland make decisions on resource allocation for people with dementia living at home and how resource constraints affect their decisions and choices. Methods: A balance of care approach was used to assess resource allocation across six dementia case types, from low to high needs. Workshops were held with 24 HSCPs from multiple disciplines. Participants allocated services in two scenarios: allocation with and without a budget constraint. Nominal group technique was used to structure discussions around resource allocation in both scenarios. Thematic analysis was applied to analyse the qualitative data using a general inductive approach. Results: The following themes influenced allocative deliberations: whose needs are being met; what needs are identified; decision making context; decision making process; and allocation outcomes. Participants were proficient in making decisions, using 'decision rules' or heuristics to help them make decisions under fixed budget rules and sticking to conventional provision when constraints were in place. Conclusions: Freedom from a budget constraint allowed HSCPs to consider a broader range of services and to take a more expansive view on what needs should be considered, with a particular emphasis on adopting a proactive, preventative approach to the allocation of resources. The effect of the budget constraint overall was to narrow all considerations, using heuristics to limit the type of needs addressed and the range of services and supports provided. The consequences were a largely reactive, less personalised system of care. The findings emphasise the need for an integrated and comprehensive assessment process that is more concerned with individualised responses rather than relying on existing models of care alone.

Resource allocation decision-making in dementia care with and without budget constraints: a qualitative analysis

Introduction: Health systems in many different countries have increasingly been reorienting the delivery of dementia care to home and community care settings. This paper provides information on how health and social care professionals (HSCPs) in Ireland make decisions on resource allocation for people with dementia living at home and how resource constraints affect their decisions and choices. Methods: A balance of care approach was used to assess resource allocation across six dementia case types, from low to high needs. Workshops were held with 24 HSCPs from multiple disciplines. Participants allocated services in two scenarios: allocation with and without a budget constraint. Nominal group technique was used to structure discussions around resource allocation in both scenarios. Thematic analysis was applied to analyse the qualitative data using a general inductive approach. Results: The following themes influenced allocative deliberations: whose needs are being met; what needs are identified; decision making context; decision making process; and allocation outcomes. Participants were proficient in making decisions, using ‘decision rules’ or heuristics to help them make decisions under fixed budget rules and sticking to conventional provision when constraints were in place. Conclusions: Freedom from a budget constraint allowed HSCPs to consider a broader range of services and to take a more expansive view on what needs should be considered, with a particular emphasis on adopting a proactive, preventative approach to the allocation of resources. The effect of the budget constraint overall was to narrow all considerations, using heuristics to limit the type of needs addressed and the range of services and supports provided. The consequences were a largely reactive, less personalised system of care. The findings emphasise the need for an integrated and comprehensive assessment process that is more concerned with individualised responses rather than relying on existing models of care alone.

The assessment of collaboration quality: a case of sugar supply chain in Indonesia

PurposeThis paper aims to evaluate the collaboration quality performance of sugar company Z and its stakeholders (farmers and distributors) by considering the sustainability aspects. This assessment shall be able to integrate qualitative and quantitative factors in the model, which is critical in sugar supply chains involving multi-stakeholders.Design/methodology/approachIntegration of quality function deployment (QFD), the fuzzy analytical network process (FANP) and the data envelopment analysis (DEA) is administered to assess the efficiency score of each stakeholder involved. The evaluation encompasses collaboration behaviour factors since the input of collaboration activities will result in sustainability aspects such as revenue, green house gas (GHG) emissions and social impact. The analysis has been conducted in two scenarios, those are the basic scenario by utilising original data and the extended scenario by using projection data.FindingsThe result clarifies that the most influential behaviour factor in the collaboration activities is commitment (0.116), while the least important behaviour factors are power (0.008) and adaptation (0.008). Furthermore, by using the extended scenario, the overall efficiency for each benchmarking is higher compared to the condition before the improvement (basic scenario).Research limitations/implicationsThe result of this study is only relevant to the particular sugar supply chain and involving limited sustainability variables. Therefore, in a further study, more variables such as technical and financial aspects could be explored further in the assessment process.Practical implicationsThe result of this study is available for each stakeholder and can be fundamental for the constant improvement in sustainable supply chain (SSC) practices. It shows that an improvement of one stakeholder will positively impact the entire system.Social implicationsSmallholders and sugarcane farmers will recognise the significance of collaboration behaviour. Thus, they can enhance their mutual benefits by using the existing resources.Originality/valueThis paper arranges for a practical contribution by implementing advanced assessment methods in the sugar supply chain by taking into account the economic, environmental and social aspects. This comprehensive assessment process in the sugar supply chain is the novelty of this paper.

PRO104 Risk Factors for NOVEL Pharmaceutical Products of Being Imposed with a Registry during the German Benefit Assessment

In Germany, novel drugs must pass a comprehensive benefit assessment process by the Federal Joint Committee (G-BA), after approval is granted by the European Medicine Agency (EMA). Since 2019, a German law intends to include real-world evidence in benefit assessments initially based on insufficient evidence. In this study, time-limited G-BA procedures with a registry requirement serving as an additional evidence base in the re-assessment were evaluated. Using the SKC MAIS-database, which is based on publicly available German benefit assessment and pricing data, time-limited benefit assessments in combination with registry requirements were identified until June 2020 and related constraints, justifications, and deadlines were analysed. For a total of 73 benefit assessments, the G-BA resolution was time-limited so far. 30 of these procedures (41%) concerned orphan drugs. In five of these orphan drug assessments, all of which received a non-quantifiable benefit, the G-BA requested for additional data collection based on a registry to close an existing evidence gap. The first benefit re-assessment of asfotase alfa was completed in April 2020 (price negotiations ongoing), whereas the other four assessments are still pending up to 2022. In all cases, the EMA previously required a patient registry in connection with the approval to gather additional evidence for long-term safety and efficacy of the drug. However, our analysis shows that EMA registry requirements differ from those by the G-BA. In 3/5 cases (60%) the G-BA requested additional registry data on patient-relevant endpoints specific for the German healthcare context. Approval and benefit assessment of orphan drugs are often based on low evidence due to small target populations. The likelihood of being imposed with a registry requirement by the G-BA for generation of additional evidence increases with a registry requested by the EMA, although methodological requirements differ considerably between the HTA authorities.

Uwarunkowania skuteczności terapii utrwalonego jąkania w opiniach logopedów i studentów logopedii

W artykule podjęto tematykę uwarunkowań skuteczności terapii jąkania utrwalonego w ocenie logopedów i studentów logopedii. W części teoretycznej zarysowano czynniki wpływające pośrednio i bezpośrednio na skuteczność terapii tego zaburzenia. Podczas badania analizie poddano czynniki mające wpływ na powodzenie terapii jąkania chronicznego. W tym celu wykorzystano metodę sondażu diagnostycznego i użyto autorskiego kwestionariusza ankiety. W badaniu wzięło udział 147 respondentów (81 logopedów oraz 66 studentów logopedii). Wyniki tego projektu badawczego wykazują, że zarówno logopedzi, jak i studenci logopedii dysponują adekwatną wiedzą na temat uwarunkowań terapii jąkania utrwalonego. Ustalono, że według ankietowanych skuteczna terapia wiąże się z zastosowaniem kompleksowej diagnozy, hybrydowych podejść terapeutycznych i różnych form terapii, dostosowanych do indywidualnych potrzeb klienta czy pacjenta. W rezultacie badań ujawniono pozytywny stosunek badanych do autoterapii klienta, jego udziału w spotkaniach grup samopomocowych oraz zaangażowania najbliższego otoczenia w proces wsparcia. Wyniki badania wskazują, że respondenci dostrzegają znaczenie jakości relacji logopeda – klient w procesie terapii. Większość badanych manifestowała jednak duże wątpliwości w związku z własnymi umiejętnościami w zakresie wdrażania terapii jąkania. W podsumowaniu zaakcentowano, że niezależnie od stosunkowo zadowalającego stanu wiedzy na temat terapii jąkania ważne jest rozwijanie umiejętności praktycznych i poczucia kompetencji logopedów i studentów logopedii w tym zakresie. Dodatkowo zwrócono uwagę na rosnące zainteresowanie tematyką zaburzeń płynności mowy.

Resource allocation decision-making in dementia care with and without budget constraints: a qualitative analysis

Introduction: Health systems in many different countries have increasingly been reorienting the delivery of dementia care to home and community care settings. This paper provides information on how health and social care professionals (HSCPs) in Ireland make decisions on resource allocation for people with dementia living at home and how resource constraints affect their decisions and choices. Methods: The study employed a balance of care approach to assess resource allocation across six dementia case types, ranging from low to high needs. Decision-making workshops were held with 24 HSCPs from a range of backgrounds. Participants were asked to allocate services and supports across dementia case types in two scenarios: allocation with and without a budget constraint. Nominal group technique was used to structure discussions around resource allocation in both scenarios. Thematic analysis was applied to analyse the qualitative data using a general inductive approach. Results: The following themes influenced allocative deliberations: whose needs are being met; what needs are identified; decision making context; decision making process; and allocation outcomes. Participants used 'decision rules' or heuristics to help them make decisions under fixed budget rules. Conclusions: Freedom from a budget constraint allowed HSCPs to consider a broader range of services and to take a more expansive view on what needs should be considered, with a particular emphasis on adopting a proactive, preventative approach to the allocation of resources. The effect of the budget constraint overall was to narrow all considerations, using heuristics to limit the type of needs addressed and the range of services and supports provided. The consequences were a largely reactive, less personalised system of care. The findings emphasise the need for an integrated and comprehensive assessment process that is more concerned with individualised responses rather than relying on existing models of care alone.

Implementation of PAUD Unit Accreditation in South Padangsidimpuan City

School accreditation is school assessment activities that are carried out systematically and comprehensively through self-evaluation and external evaluation (visitation) activities to determine the feasibility and performance of the school. Accreditation has a meaning as a comprehensive assessment process of the appropriateness and performance of an institution or an educational program as a form of public accountability, a self regulation tool in which schools recognize strengths and weaknesses and continuously improve strengths and improve their weaknesses. This understanding will give more meaning in the results as an acknowledgment, a school has met the specified eligibility standards. Padangsidimpuan City as one of the cities in Indonesia is not immune from the policy to carry out accreditation in each of its educational institutions or units. Some education units have carried out accreditation in the District of South Padangsidimpuan. In carrying out accreditation, the institution certainly cannot be separated from the constraints that must arise, both internal and external constraints. Government efforts to develop human resources through PAUD and PAUD education units have encouraged education units to meet eight (8) National Education Standards (SNP). In the framework of meeting these standards, the central government and regional governments prepare education units to be ready to be accredited on an ongoing and ongoing basis in the hope that the accreditation process can improve the quality of education units. Especially in the city of Padangsidimpuan, South Padangsidimpuan Subdistrict. Based on the results of the interviews. Obtained data from the Padangsidimpuan City Education Office for South Padangsidmpuan Subdistrict, with a total of 17 units, more than 50% have been accredited, 9 are accredited institutions and 8 institutions have B grades and 1 institution with a value of C. Provide an overview of the level of school performance that is used as a tool for coaching, developing and improving schools both in terms of quality, effectiveness, efficiency, productivity and innovation. Providing guarantees to the public that the school has been accredited and provides educational services that meet national accreditation standards.

A Pilot Study of Airborne Hazards and Other Toxic Exposures in Iraq War Veterans.

During their deployment to Iraq in support of Operation Iraqi Freedom (OIF), many Veterans were exposed to a wide array of toxic substances and psychologic stressors, most notably airborne/environmental pollutants from open burn pits. Service members do not deploy whilst unhealthy, but often they return with a multitude of acute and chronic symptoms, some of which only begin to manifest years after their deployment. Our findings, while preliminary in nature, suggest that Iraq War Veterans who participated in our survey reported a decrease in overall physical fitness and increased respiratory clinical symptoms compared with pre-deployment periods. The objective of this report is to provide information that will benefit how combat Veterans are cared for post-deployment. Strategies for a wider and more comprehensive assessment and medical screening process post-deployment are recommended.

Hearing and Responding to Marginalized Voices: Tangible Guidance for Comprehensive Inclusive Assessment

AbstractIntegrating a comprehensive assessment process and synthesizing the guidance and examples of the chapters within this volume, we offer key implications for the conduct of inclusive assessment practices to achieve social justice and equity in higher education institutions.

Community mobility plans for individuals with developmental disabilities: A feasibility study

Introduction Individuals with intellectual and/or developmental disabilities have unmet transportation needs, which limits their community mobility. Access to transportation is linked to community participation and independence in adult outcomes. The purpose of this study is to examine the implementation feasibility of individualized community mobility plans. Methods A pre-test post-test one group design was used to determine if methodology and implementation procedures were feasible. Outcome measures were evaluated to determine if appropriate for future effectiveness research. Participants were six adults with intellectual and/or developmental disabilities who received the community mobility plans intervention over a period of 3–8 sessions. Community mobility plans use a cyclical process where the individual first develops self-determined community mobility goals, followed by a comprehensive assessment process, and individualized environmental and person-centered travel interventions. Results Participants demonstrated significant improvement between pre- and post-test scores on the measures of the Progressive Evaluation of Travel Skills ( t(5) = –4.481, p = .007) and Goal Attainment Scaling ( t(5) = –7.457, p =.001). Conclusion Community mobility plans may provide a feasible option to improve community mobility for individuals with intellectual and/or developmental disabilities, although further research is needed to determine effectiveness.

A comprehensive assessment process for children with autism spectrum disorders

PurposeThe assessment of Autism Spectrum Disorders (ASD) in childhood has two essential aspects: the identification of the risk (under 30 months of age) and the definition of a diagnosis that takes into account its core areas as well as further non-specific aspects. The purpose of this paper is to present an approach that considers the combination of clinical evaluation with the use of tools that analyse the various levels of the child’s functioning as fundamental.Design/methodology/approachThe comprehensive assessment at the Institute of Ortofonologia in Rome provides the ADOS-2 and the Leiter-R for the evaluation of the symptomatology, the severity level, the non-verbal cognitive functioning and the fluid reasoning; the TCE and the UOI are used to identify, respectively, the child’s emotional skills and the ability to understand the intentions of others, as precursors of the theory of mind. Within this assessment, the Brief-P, the Short Sensory Profile and the RBS are also included for the evaluation of executive functions, sensory pattern and of restricted and repetitive behaviours, as observed by parents.FindingsHow to define a reliable development profile, which allows to plan a specific intervention calibrated on the potential of the child and on his development trajectory, is described. Two clinical cases are also presented.Originality/valueThe entire process is aimed both at a detailed assessment of the child’s functioning and at identifying a specific therapeutic project and predictive factors for achieving an optimal outcome.

Living In Place: the Impact of Smart Technology

To discuss impact of smart technology and highlight specific types of technologies that would be supportive of older adults to Live In Place. Smart technology has potential to increase the ability of older adults to remain in their homes by monitoring health, safety, and falls, preventing potential accidents and injuries. Several types of smart technology were identified in the literature as supportive of Living In Place. These include sensor systems with predictability analysis, wearable technology, information and communication technology, and smart homes. In general, the less intrusive and less high maintenance a smart technology, the better received it is by an older adult. Several considerations need to be made when choosing an appropriate smart technology device. Older adults’ views, beliefs, and comfort regarding smart technology play a large role in adoption rate. Smart technology use requirements also need to match the older adult’s abilities, while supporting areas of impairment. Finally, clinicians need to consider ethics regarding smart technology, such as privacy concerns and informed consent. As a result, a comprehensive assessment process is necessary in order to make appropriate recommendations. Smart technology is an increasingly large part of our world with more devices being developed every day. It is important to take into consideration the older adult’s needs, abilities, and tolerance for technology in general, while also considering the features of devices before making recommendations. The appropriate smart technology has the potential to increase the ability of older adults to remain in their homes by supporting their independence in daily activities.

Risks Perceived by Frail Male Patients, Family Caregivers and Clinicians in Hospital: Do they Change after Discharge? A Multiple Case Study.

Introduction:Up to 40% of hospitalised seniors are frail and most want to return home after discharge. Inaccurate estimation of risks in the hospital may lead to inadequate support at home. This study aimed to document convergences and divergences between risks and support needs identified before hospital discharge and perceived at home post-discharge.Methods:This research used a multiple case study design. Three cases were recruited, each involving a hospitalised frail patient aged 70+, the main family caregiver and most of the clinicians who assessed the patient before and after hospital discharge. Thirty-two semi-structured interviews were conducted and their transcripts analysed using a qualitative thematic analysis approach.Results:Among risks raised by participants, falls were the only one with total inter-participant/inter-time/inter-case convergence. In all cases, all participants mentioned, before and after discharge, home adaptations and use of technical aids to mitigate this risk. However, clinicians recommended professional services while patients and family caregivers preferred to rely on family members and their own coping strategies.Conclusion:The divergences identified for most risks and support needs between users and clinicians, before and after discharge, provide new insights into a comprehensive and patient-centred risk assessment process to plan hospital discharge for frail elderly.

Reliability-based Evaluation of River-bridge Flood Resistance Ability Via a Visual Inspection Table

This research establishes a reliability-based preliminary evaluation table for assessing river-bridge flood resistance. Flood resistance for a river-bridge is affected by numerous factors, including bridge structure, river environment, hydrology, and riverbank protection infrastructure. Flood resistance assessment is a complex issue that involves multiple areas of expertise. A comprehensive assessment process is extremely time-consuming and difficult to implement in practice, especially given the limited time and resources. Many bridges require risk evaluations. A preliminary visual inspection is often conducted in response to these problems. The primary issue with visual inspection is the high subjectivity regarding the understanding and standards for the various indicators. To solve this issue, a Bayesian Network (BN) is proposed to combine the contributions from experts and reliability analyses. Eight bridges are selected for performing FOSM-based reliability calculations using a parameterized ABAQUS model. An ideal preliminary inspection table enables a close relationship with the failure probability that is calculated from an advance analysis. Thus, PSO is employed to maximize the correlation between the scores obtained from the visual inspection table and the failure probability calculated from the BN to establish a reliability-based visual inspection table that provides a strong foundation for a bridge risk analysis.

A Shared Multi-Disciplinary Creativity Requirement for First Year Students

Even though interest in embedding creativity into tertiary curricula has grown internationally, little scholarship exists about implementation strategies or the efficacy of linking creativity pedagogies to first-year experience programs. This practice report describes how Suffolk University in Boston, Massachusetts, inserted a new creativity requirement for first-year students as a part of curriculum reform in the College of Arts and Sciences and in the Sawyer Business School in spite of considerable resistance. It will demonstrate the uniqueness of the approach and suggest anticipated outcomes in advance of a comprehensive assessment process now underway.
 

Republication of “Functional Analysis of Classroom Variables for Students with Emotional and Behavioral Disorders”

Functional assessment and functional analysis are processes that have been applied successfully in work with people who have developmental disabilities, but they have been used rarely with students who experience emotional or behavioral disorders. In the present study, five students in elementary school programs for severe emotional disturbance participated in a comprehensive functional assessment process designed to yield a useful understanding of their desirable and undesirable behaviors. Interviews, record reviews, and direct classroom observations led to the development of individualized hypotheses regarding relationships between classroom events and the occurrence of target behaviors. Subsequently, direct manipulations (i.e., functional analyses) were conducted to test each of the hypotheses in the context of regularly-occurring classroom activities. These analyses demonstrate important influences that certain classroom variables can exert over individual student’s behavior. The process and results are discussed with regard to the need for improved methods for understanding student responding, and the benefits that functional assessment can offer programs of educational and behavioral support.

Comprehensive Assessment of Struggling Learners Referred to a Graduate Medical Education Remediation Program.

Implementation of the Next Accreditation System has provided a standardized framework for identifying learners not meeting milestones, but there is as yet no corresponding framework for remediation. We developed a comprehensive assessment process that allows correct diagnosis of a struggling learner's deficit(s) to promote successful remediation. At the University of Pennsylvania, resident learners within the Department of Medicine who are not meeting milestones are referred to the Early Intervention Remediation Committee (EIRC). The EIRC, composed of 14 faculty members with expertise in remediation, uses a standardized process to assess learners' deficits. These faculty members categorize primary deficits as follows: medical knowledge, clinical reasoning, organization and efficiency, professionalism, and communication skills. The standardized process of assessment includes an analysis of the learner's file, direct communication with evaluators, an interview focused on learner perception of the problem, screening for underlying medical or psychosocial issues, and a review of systems for deficits in the 6 core competencies. Participants were surveyed after participating in this process. Over a 2-year period, the EIRC assessed and developed remediation plans for 4% of learners (14 of a total 342). Following remediation and reassessment, the identified problems were satisfactorily resolved in all cases with no disciplinary action. While the process was time intensive, an average of 45 hours per learner, the majority of faculty and residents rated it as positive and beneficial. This structured assessment process identifies targeted areas for remediation and adds to the tools available to Clinical Competency Committees.

‘Gaps, mishaps and overlaps’. Nursing documentation: How does it affect care?

Complete, accurate and relevant nursing documentation is essential for the multidisciplinary comprehensive geriatric assessment (CGA) process which can improve older patients’ outcomes following a hospital admission. Our aim is to understand older person nurses’ experiences of and attitudes to documentation, via semi-structured, in-depth interviews of eight qualified nurses at an acute hospital trust. Interviews were analysed using the framework approach to identify key themes. Three overarching themes were identified: gaps, mishaps and overlaps. Gaps refer to information which was missing, inaccurate or inconsistent; mishaps refer to the consequences of these inaccuracies and inconsistencies; and overlaps refer to the problem of duplications in recording of information. Older person nurses report many inconsistencies, omissions and duplications in their documentation. This has implications for how nursing contributes to the CGA and the quality of care of older patients. New ways must be found to minimise and streamline existing documentation to ensure that records are complete, timely and person-centred. Nurses should be mindful that emerging digital technology systems do not create further problems. Ward nurses need to take greater control of development of documentation.